What “informed consent” really means

Stacy Weiner
www.aamcnews.org
Originally published January 19, 2019

Here is an excerpt:

Conflicts around consent

The informed consent process is not without its thornier aspects. At times, malpractice suits shift the landscape. For example, in a 2017 Pennsylvania case with possible implications in other states, the court ruled that the physician performing a procedure — not a delegate — must personally ensure that the patient understands the risks involved.

And sometimes, informed consent grabs headlines, as happened recently with allegations that medical students are performing pelvic exams on anesthetized women without consent.

That claim, Orlowski notes, relied on studies from more than 10 years ago, before such changes as more detailed consent forms. Typically, she says, students practice pelvic exams with special mannequins and standardized patients who are specifically trained for this purpose. When students and residents do perform pelvic exams on surgical patients, Orlowski adds, specific consent must be obtained first. “Performing pelvic examinations under anesthesia without patients’ consent is unethical and unacceptable,” she says.

In fact, the American College of Obstetricians and Gynecologists states that “pelvic examinations on an anesthetized woman … performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.”

Marie Walters, a student at Wright State University Boonshoft School of Medicine, says she was perplexed by the allegations, so she checked with fellow students at her school and elsewhere. Her explanation: medical students may not know that patients agreed to such exams. “Although students witness some consent processes, we’re likely not around when patients give consent for the surgeries we observe,” says Walters, who is a member of the AAMC Board of Directors. "We may be there just for the day of the surgery,” she notes.

The info is here.

(Ideo)Logical Reasoning: Ideology Impairs Sound Reasoning

Anup Gampa, Sean Wojcik, Matt Motyl, Brian Nosek, & Pete Ditto
PsycArXiv
Originally posted January 15, 2019
 
Abstract

Beliefs shape how people interpret information and may impair how people engage in logical reasoning. In 3 studies, we show how ideological beliefs impair people's ability to: (1) recognize logical validity in arguments that oppose their political beliefs, and, (2) recognize the lack of logical validity in arguments that support their political beliefs. We observed belief bias effects among liberals and conservatives who evaluated the logical soundness of classically structured logical syllogisms supporting liberal or conservative beliefs. Both liberals and conservatives frequently evaluated the logical structure of entire arguments based on the believability of arguments’ conclusions, leading to predictable patterns of logical errors. As a result, liberals were better at identifying flawed arguments supporting conservative beliefs and conservatives were better at identifying flawed arguments supporting liberal beliefs. These findings illuminate one key mechanism for how political beliefs distort people’s abilities to reason about political topics soundly.

The research is here.

Leaders matter morally: The role of ethical leadership in shaping employee moral cognition and misconduct.

Moore, C., Mayer, D. M., Chiang, F. F. T., Crossley, C., Karlesky, M. J., & Birtch, T. A. (2019). Journal of Applied Psychology, 104(1), 123-145.

Abstract

There has long been interest in how leaders influence the unethical behavior of those who they lead. However, research in this area has tended to focus on leaders’ direct influence over subordinate behavior, such as through role modeling or eliciting positive social exchange. We extend this research by examining how ethical leaders affect how employees construe morally problematic decisions, ultimately influencing their behavior. Across four studies, diverse in methods (lab and field) and national context (the United States and China), we find that ethical leadership decreases employees’ propensity to morally disengage, with ultimate effects on employees’ unethical decisions and deviant behavior. Further, employee moral identity moderates this mediated effect. However, the form of this moderation is not consistent. In Studies 2 and 4, we find that ethical leaders have the largest positive influence over individuals with a weak moral identity (providing a “saving grace”), whereas in Study 3, we find that ethical leaders have the largest positive influence over individuals with a strong moral identity (catalyzing a “virtuous synergy”). We use these findings to speculate about when ethical leaders might function as a “saving grace” versus a “virtuous synergy.” Together, our results suggest that employee misconduct stems from a complex interaction between employees, their leaders, and the context in which this relationship takes place, specifically via leaders’ influence over employees’ moral cognition.

Here is the Conclusion:

Our research points to one of the reasons why 'cleaning house' of morally compromised leaders after scandals may be less effective than we might expect. The fact that leadership affects the extent to which subordinates morally disengage means that their influence may be more profound and nefarious than one might conclude given earlier understandings of the mechanisms through which ethical leadership elicits its outcomes. One can eliminate perverse incentives and remove poor role models, but once a leader shifts how subordinates cognitively construe decisions with ethical import, their continuing influence on employee misconduct may be harder to undo.

The info is here.

A systematic review of therapist effects: A critical narrative update and refinement to Baldwin and Imel's (2013) review

Robert G. Johns, Michael Barkham, Stephen Kellett, & David Saxon.
Clinical Psychology Review
Volume 67, February 2019, Pages 78-93

Abstract

Objective

To review the therapist effects literature since Baldwin and Imel's (2013) review.

Method

Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included studies conducted.

Results

Twenty studies met inclusion criteria (3 RCTs; 17 practice-based) with 19 studies using multilevel modeling. TEs were found in 19 studies. The TE range for all studies was 0.2% to 29% (weighted average = 5%). For RCTs, 1%–29% (weighted average = 8.2%). For practice-based studies, 0.2–21% (weighted average = 5%). The university counseling subsample yielded a lower TE (2.4%) than in other groupings (i.e., primary care, mixed clinical settings, and specialist/focused settings). Therapist sample sizes remained lower than recommended, and few studies appeared to be designed specifically as TE studies, with too few examples of maximising the research potential of large routine patient datasets.

Conclusions

Therapist effects are a robust phenomenon although considerable heterogeneity exists across studies. Patient severity appeared related to TE size. TEs from RCTs were highly variable. Using an overall therapist effects statistic may lack precision, and TEs might be better reported separately for specific clinical settings.

The research is here.

In battle against doctor burnout, reading—for fun—is fundamental

Sara Berg
American Medical Association News
Originally posted January 18, 2019

Here is an excerpt:

How reading replenishes

One survey of 513 physicians examined the impact of non-medical reading habits on burnout. The chances of emotional exhaustion or depersonalization fell as physicians became more consistent readers.

When compared to nonreaders, the relative risk of burnout for consistent readers—those who read at least one book per month—fell by 19 percent across the emotional exhaustion and 44 percent across the depersonalization domain.

In an unpublished study by Dr. Marchalik, more than 200 urology trainees were surveyed about work characteristics, as well as relaxation techniques. These included watching movies, meditation, yoga, reading and other ways of relaxing. Meditation, exercise and yoga were not protective against burnout— but reading was.

Controlling for the biggest predictors of burnout, which were resident level, work hours and gender, reading made an impact: the odds of burnout decreased by 59 percent for residents who read for relaxation. A similar effect was seen in Dr. Marchalik’s national survey of palliative care providers, in which the odds of burnout dropped by 39 percent for readers, even when controlling for age, clinical discipline and the presence of fatigue.

The info is here.

Intellectual humility: the importance of knowing you might be wrong

Brian Resnick
vox.com
Originally posted January 4, 2019

Here is an excerpt:

Social psychologists have learned that humility is associated with other valuable character traits: People who score higher on intellectual humility questionnaires are more open to hearing opposing views. They more readily seek out information that conflicts with their worldview. They pay more attention to evidence and have a stronger self-awareness when they answer a question incorrectly.

When you ask the intellectually arrogant if they’ve heard of bogus historical events like “Hamrick’s Rebellion,” they’ll say, “Sure.” The intellectually humble are less likely to do so. Studies have found that cognitive reflection — i.e., analytic thinking — is correlated with being better able to discern fake news stories from real ones. These studies haven’t looked at intellectual humility per se, but it’s plausible there’s an overlap.

Most important of all, the intellectually humble are more likely to admit it when they are wrong. When we admit we’re wrong, we can grow closer to the truth.

One reason I’ve been thinking about the virtue of humility recently is because our president, Donald Trump, is one of the least humble people on the planet.

The info is here.

A Study on Driverless-Car Ethics Offers a Troubling Look Into Our Values

Caroline Lester
The New Yorker
Originally posted January 24, 2019

Here is an excerpt:

The U.S. government has clear guidelines for autonomous weapons—they can’t be programmed to make “kill decisions” on their own—but no formal opinion on the ethics of driverless cars. Germany is the only country that has devised such a framework; in 2017, a German government commission—headed by Udo Di Fabio, a former judge on the country’s highest constitutional court—released a report that suggested a number of guidelines for driverless vehicles. Among the report’s twenty propositions, one stands out: “In the event of unavoidable accident situations, any distinction based on personal features (age, gender, physical or mental constitution) is strictly prohibited.” When I sent Di Fabio the Moral Machine data, he was unsurprised by the respondent’s prejudices. Philosophers and lawyers, he noted, often have very different understandings of ethical dilemmas than ordinary people do. This difference may irritate the specialists, he said, but “it should always make them think.” Still, Di Fabio believes that we shouldn’t capitulate to human biases when it comes to life-and-death decisions. “In Germany, people are very sensitive to such discussions,” he told me, by e-mail. “This has to do with a dark past that has divided people up and sorted them out.”

The info is here.

HHS issues voluntary guidelines amid rise of cyberattacks

Samantha Liss
www.healthcaredive.com
Originally published January 2, 2019

Dive Brief:

• To combat security threats in the health sector, HHS issued a voluminous report that details ways small, local clinics and large hospital systems alike can reduce their cybersecurity risks. The guidelines are voluntary, so providers will not be required to adopt the practices identified in the report. 

• The four-volume report is the culmination of work by a task force, convened in May 2017, that worked to identify the five most common threats in the industry and 10 ways to prepare against those threats.  

• The five most common threats are email phishing attacks, ransomware attacks, loss or theft of equipment or data, accidental or intentional data loss by an insider and attacks against connected medical devices.

The info is here.

A more comprehensive source can be found here.

Experts Reveal Their Tech Ethics Wishes For The New Year

Jessica Baron
Forbes.com
Originally published December 30, 2018

Here is an excerpt:

"Face recognition technology is the technology to keep our eyes on in 2019.

The debates surrounding it have expressed our worst fears about surveillance and injustice and the tightly coupled links between corporate and state power. They’ve also triggered a battle amongst big tech companies, including Amazon, Microsoft, and Google, over how to define the parameters of corporate social responsibility at a time when external calls for greater accountability from civil rights groups, privacy activists and scholars, and internal demands for greater moral leadership, including pleas from employees and shareholders, are expressing concern over face surveillance governance having the potential to erode the basic fabric of democracy.

With aggressive competition fueling the global artificial intelligence race, it remains to be seen which values will guide innovation."

The info is here.